Speech Info 101 - Cleft Palate

Cleft Palate

“Palate” is another name for the roof of your mouth. The palate is both the roof of your mouth and the floor of your nose. The palate has two parts: the front, or hard palate, and the back, or soft palate. The hard palate is made of bone and the soft palate is made of muscle.

A cleft palate is an opening or split in the roof of the mouth that occurs when the tissue doesn't fuse together during development in the womb. A cleft palate often includes a split (cleft) in the upper lip (cleft lip) but can occur without affecting the lip. Children with a cleft palate often have problems with feeding and speaking clearly and can have ear infections. They also might have hearing problems and problems with their teeth. Sometimes, multiple surgeries are needed to get complete closure of the palate.

Kids and Parents Share Their Stories with Cleft Palate and Cleft Lip

Josh

Benjamin

SPEECH

A child with a cleft lip may not have many speech problems. A child with a cleft palate may need help learning to make sounds and speak clearly.

Some children have problems with their soft palate. The soft palate needs to move when we speak, to prevent air from escaping into your nose and causing a hypernasal quality. When that happens, it becomes difficult for the child to produce many of the speech sounds in English. The soft palate needs to move to touch the back of the throat. This closes the space between our mouth and nose. We need to do this so that most sounds can come out of our mouth. Some sounds, like "m" and "n," come out of our nose. The soft palate needs to stay open for these sounds.

Velopharyngeal Impairment (VPI) may happen when a child has a cleft palate. It can also happen to children who do not have a cleft palate. VPI is when the soft palate does not properly close off the mouth from the nose while speaking, therefore, air escapes through the nose. Additionally, if there are still holes (fistulas) in the palate, this makes it difficult to make some "pressure" consonant sounds because they require placing the tongue there to make the sound. Some children may need additional surgery to reduce the amount of air escaping through their nose when they speak. This is called secondary speech surgery and there are a number of procedures used such as a "pharyngeal flap" or "pharyngoplasty" (ASHA MORE INFO )

Speech Sound Development in Children with a Cleft Palate

The Process of Speech: For specific sounds, the soft palate, which is located behind the hard palate in the back of and top of the mouth, needs to rise to touch the back of the throat to close the nasal passage to allow pressure to build for pressure consonants. English language pressure consonants that need the closure of the soft palate are: /p, b, t, d, k, g, f, v, s, z, sh, ch, j (-dg, -dge), and "th." A child who has an unrepaired cleft palate cannot build-up the necessary pressure to make these sounds. They can, however, make "low pressure" consonants and vowels. English language "low pressure" sounds are: vowels, /m, n, -ng, h, l, w, y, r/.

Children with a cleft palate demonstrate compensatory strategies to make sounds in a different way in order to block airflow in their throat. This throat sound aka "guttural" or "glottal" sound will sound like a "grunt," throaty, growl-like or a "ger" sound.

Speech Therapy

The SLP, in regards to sound production, will focus on getting the student to articulate correct placement, manner and air pressure to produce the target sound. Speech therapy can only correct abnormal placement, including compensatory productions that result in nasal emission even after the cleft is repaired. It will change speech habits that the child has used to compensate, which have been used over time and will not automatically change because of the repair.

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